Background/Purpose: Mental health problems are prevalent in pediatric systemic lupus erythematosus (SLE). We aimed to compare the rates of mental health problems and mental health services use for children and adolescents with SLE and mixed connective tissue disease (MCTD) to healthy peers and those with other chronic disease. 

Methods: In a cross-sectional analysis, 40 children and adolescents with SLE/MCTD were matched according to sex and age with 40 healthy and 40 type 1 diabetic controls. Subjects were consecutively recruited and consented at outpatient clinic visits. We screened for symptoms of depression, suicidal ideation and anxiety using the Patient Health Questionnaire 9 (PHQ-9) and the Screen for Child Anxiety Related Disorders (SCARED), respectively. We also assessed for use of mental health services in the previous 12 months by parent report. We used matched pair analysis to compare the rate of mental health symptoms, and the Fisher’s exact test to compare rates of mental health services use among the groups.

Results: Mental health symptoms were prevalent in all groups with 33% (13) of SLE/MCTD, 30% (12) of healthy controls and 43% (17) of diabetic controls screening positive for any symptom. Compared to the 10% prevalence of depression symptoms in the healthy controls, there was a trend towards higher prevalence in the SLE/MCTD group at 23% (RR=2.3, 95%CI 0.8-6.6) and statistically higher prevalence in the diabetes group at 30% (RR=2.5, 95%CI 1.2-5.3). Compared to the 5% prevalence of suicidal ideation in the healthy controls, there was a trend towards higher prevalence in the SLE/MCTD group at 18% (RR=3.5, 95%CI 0.7-16.8) and in the diabetes group at 18% (RR=2.5, 95%CI 0.9-7.3), but these were not statistically significant. There was no difference in depression and suicidal symptoms between the SLE/MCTD and diabetes groups. Anxiety was prevalent among all groups, but there was no difference between the groups. In those with any symptom, previous mental health care had been obtained in none (0/12) of the healthy controls, 23 % (3/13) of the SLE/MCTD and 53% (9/17) of the diabetes groups. Compared to healthy controls, the diabetes group had a statistically significant higher rate of mental health care in those with symptoms (p=0.003), but there was no difference for the SLE/MCTD group (p=0.12). There was no statistically significant difference in mental health care rates between SLE/MCTD and diabetic patients with symptoms (p=0.14).

Conclusion: Mental health symptoms were common in pediatric SLE/MCTD patients and their peers, but there was a trend towards more frequent depression and suicidal ideation in the SLE/MCTD and diabetes groups, implicating chronic disease as a risk factor for these symptoms. The majority of those with symptoms had no previous mental health care, although those with diabetes had a significantly higher rate of mental health care compared to healthy peers. Further study of the risk factors for mental health problems in chronic illness and factors affecting mental health care may improve overall care for pediatric SLE/MCTD patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-cross-sectional-study-of-mental-health-symptoms-and-mental-health-care-in-pediatric-slemctd-patients-and-their-peers/